occurs in 3 5 of all pregnancies most common malpresentation sometimes can get

Occurs in 3 5 of all pregnancies most common

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– occurs in 3-5% of all pregnancies, most common malpresentation, sometimes can get baby to turn; incidence is related to gestational age (more common in preterm baby); more risk of breech with multiples; more likely if hydramnios o Types of Breech Frank – most common, legs up in front of face Footling – foot is coming out Complete – baby is sitting Indian style o Breech babies are more liked to have congenital anomalies Risks: o mom – more tears o Baby – trauma to presenting part o Prolapsed cord – greater risk if baby is breeched; put mom’s head of bed back so baby hopefully moves back C/S What to do for malpresentation? o May try an external cephalic version (ECV) – goal is to prevent a C/S Deliberately altering fetal position; can be done externally or intrauterine Relax uterus & try to get baby to turn head down Give Mag Sulfate or Terabutline Externally Done at 37 weeks’ gestation because may induce labor DO NOT want water to break so need intact membranes and normal amount of amniotic fluid Reactive NST to make sure baby is ok Presenting part not engaged Macrosomia baby : >8.5 pounds/ 4,000 grams o Most common complication is shoulder dystocia 43
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o McRoberts Position – pull knees closer to chest; widens the angle of the pelvis for delivery o Risks Complicated labor Trauma to mom – lacerations Trauma to baby – Clavicle breaking Heals on its own Erb’s palsy- trauma to side of body that had to pulled Usually temporary May require physical therapy Non-reassuring fetal status/fetal distress o Notable clues: decreased FHR (fetal heart rate) meconium stained fluid What to do? o Place mom on her side – preferably left side o Give oxygen to mom o IV fluids to mom o Monitor baby o Prep for delivery Assessment of fetal well-being/development/maturity in pregnancy (to include various procedures implemented) Assessment of fetal wellbeing: Indications for testing Age of Mom (younger or older) Maternal Conditions (HTN, DM) Rh Isoimmunization (sensitized to Rh factor, antibodies, baby is at risk for hemolytic disease of the newborn) Hx. of stillbirth (concerned, may need special testing) o IUGR (intrauterine growth restriction) (>42 weeks gest.) Amniotic Fluid Concerns (oligiohydramnios, polyhydramnios) Multiples (increases risk) Abnormal test results during pregnancy (red flags) Normal newborn assessment findings (to include V.S., Apgar, skin, physical characteristics, reflexes, stools, weight gain/loss, gestational age determination, etc. Review NB information from lab day) Apgar 1 and 5 minutes 0-3 severe distress Normal pulse : 120-160 (low as 100 during sleep, high as 180 during crying) Respirations: 30-60, brief periods of apnea Temperature 97.5-99 (Axillary B/P : 90-60/50-40 mm Hg at birth o Maintain clear airway, neutral thermal environment Within one hour of birth: single injection of vitamin K to the vastus lateralis muscle Ophthalmic erythromycin ointment to prevent eye infection from gonorrhea or Chlamydia, which can cause blindness Within one hour of birth Signs of neonatal distress : o
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